The Efficiency of Glucocorticoid Therapy in Secondary-progressive Course of Multiple Sclerosis

We have investigated the efficacy of pulse-therapy with glucocorticoids (GC) at different time stages (in debuts, at the recurrent stage and at the stage of progression) of secondary progressive course (SPC) of multiple sclerosis (MS) in 70 patients (57 women and 13 men) at the ages from 28 to 67 years (mean age 45±2.5 years). The duration of the disease accounted for 7 up to 34 years (average duration was 19.8±2.3 years). We have conducted 438 courses of GC therapy: at the onsets – 11, at the recurrent stage (RS) – 178 and at the stage of secondary progression-249.The efficacy of hormonal therapy was assessed taking into account the following criteria: the dynamics of regression of neurological symptoms under the influence of the first course of GC therapy at the stage of onsets; a comparative evaluation of remission\u27s duration after admission and without taking GC at the onsets; duration of RS depending on the duration of remissions after the first course of GC therapy; a comparative evaluation of remissions\u27 duration after the 1st (at the stage of onset and/or on the RS), and the period of stabilization on the SPS before the last courses of GC; the variants of secondary progression under the influence of GC courses; scores according the EDSS disability scale after the 1st and before the last course of GC therapy; the rate of progression under the influence of the repeated courses of GC therapy.We have defined the three categories of efficacy at the repeated courses of pulse therapy with GC: the moderate efficacy, the low efficacy, the lack of efficacy. We have not observed the high efficacy in patients with SPC.The patients with MFR <1.0, among which the pulse therapy with GC promoted the prolongation of RS, relieved the severe (less often) and moderate (more often) relapses, the outcome of which was accompanied by a moderate and stable neurologic deficit, were subsumed under the subgroup with moderate efficacy (21 individuals). The most favorable progressive variant of progression prevailed in these patients after transformation of RS into SPS.The patients with different rate of MFR (9 – with MFR <1.0 and 12 – with MFR>1.0), with short (more often) and moderate (less often) RS, during which the accumulation of neurological deficit due to the frequent and heavy relapses had occurred, were subsumed under the subgroup with low efficiency (21 individuals). After transformation into SPS, the recurrent variant of progression prevailed in these patients.The patients who were characterized by short RS, by predominance of severe and prolonged relapses, the MFR value greater than 1.0, the steady accumulation of a pronounced and persistent neurologic deficit, a high rate of progression and high scores on the EDSS disability scale more than 6.5 points) were subsumed under the subgroup with the lack of efficacy (28 individuals). After transformation in the SPC, the most unfavorable variant of progression prevailed (21 patients); significantly less frequent were the recurrent (5 patients) and a combination of a steady and recurrent (2 patients) progression. The persistent lack of efficacy of the hormonal therapy in this subgroup of patients was most likely associated with the genetically determined low individual sensitivity to GC.Therefore, the results of our study showed that the efficacy of GC therapy in SPC of MS is determined by the complex interaction of clinical indicators having the prognostic value, as well as by the number of the genetic factors, which require their further observation

Matrix Metalloproteinase-9 and Inflammation in Different Types of Multiple Sclerosis

Different clinical courses of multiple sclerosis, heterogeneity of its clinical implications, different effect of immunomodulatory therapy for the same clinical forms implies various pathogenetic mechanisms of central nervous system damage at this disease. Applicability of immunological and biochemical markers for the estimation of immunocorrecting and anti-inflammatory therapy efficacy is important. This research aims at improvement of pathological process stages diagnostics at multiple sclerosis and further therapy optimization depending on the activity of the inflammatory process. In the article matrix metalloproteinase-9 rate was assessed in 135 patients with multiple sclerosis of different course types and at different activity stages of the pathological process. The highest matrix metalloproteinase-9 rates were in patients with relapsing-remitting type at the stage of exacerbation, with the lowest rate being in patients with primary-progressive multiple sclerosis. Determination of matrix metalloproteinase-9 rate allows to assess the degree of inflammatory process expression and to monitor the efficacy of multiple sclerosis treatment

СодЕржаниЕ тАу-протеинА В плазмЕ кровИ прИ прогредиентныХ типаХ течениЯ рассеяннОгО склерозА

Цель исследования. Выявление количественных диагностических показателей тау-протеина для прогноза прогредиентных типов течения (ПТТ) рассеянного склероза.Материалы и методы исследования. Содержание тау-белка в сыворотке крови определялось в трех группах у 75 больных с разными типами течения РС: 1-я группа – 30 больных (20 женщин и 10 мужчин) с вторично-прогредиентным течением; 2-я группа – 15 больных (6 женщин и 9 мужчин) с первично-прогредиентным течением; 3-я группа (контрольная) – 30 больных (24 женщины и 6 мужчин) с рецидивирующим течением.Показатель тау-протеина определялся в лаборатории нейрофизиологии, иммунологии и биохимии ГУ Институт неврологии психиатрии и наркологии Национальной академии медицинских наук Украины иммунофлуоресцентным методом. Этот метод дает возможность выявления субклеточного компонента с помощью специфической иммунологической реакции. Он обладает высокой специфичностью и чувствительностью. Были использованы стандартные наборы производства фирмы «Sigma» (США). Данный метод дает возможность как качественного визуального описа­ния особенностей распределения оптической плотности тау-белка у каждого пациента, так и количественного определения уровня тау-белка в сыворотке крови.Результаты исследования. Проведена сравнительная оценка содержания тау-протеина в зависимости от типа течения, гендерных различий, возраста больных в момент исследования, возраста начала заболевания (клинического дебюта), длительности заболевания, уровня неврологического дефицита по шкале инвалидизации EDSS и поиск прогностического количественного диагностического показателя. Проведенные исследования показали, что уровень тау-протеина в сыворотке крови зависит от типа течения рассеянного склероза и преобладает при прогредиентных типах течения по сравнению с группой сравнения больных с ремитирующим типом течения. Влияние гендерного фактора на содержание тау-протеина при разных типах течения рассеянного склероза носило избирательный характер и преобладало только у женщин при первично-прогредиентном типе течения. Обнаружены сложные взаимоотношения между уровнем тау-протеина, возрастом дебюта, длительностью заболевания и типом течения рассеянного склероза.Выводы. 1. Проведенное исследование свидетельствует о том, что тау-протеин участвует в механизмах формирования дегенеративного процесса при прогредиентных типах течения РС.2. Получены данные о возможном применении этого критерия в комплексе прогноза прогредиентных типов течения рассеянного склероз